RACHEL MARTIN, HOST:
There's more attention than ever before on this country's opioid crisis. And cities are scrambling to figure out how to best address the epidemic. We'll hear in a moment how the Seattle area is considering a controversial proposal to cut down on overdose and addiction. Some overdoses are due to the illicit use of opioid painkillers like fentanyl, which is 100 times more potent than morphine. Carfentanil is an even more potent drug, and it's been popping up across the U.S., causing a surge in overdoses. And first responders are struggling to keep up. Side Effects Public Media's Jake Harper reports from Cincinnati.
JAKE HARPER, BYLINE: I'm riding with Officer Jamie Landrum on the west side of the city, which was hit hard during a string of overdoses a few weeks ago. She says officers were stretched thin.
JAMIE LANDRUM: And it was exactly what they were reporting. We were literally going from one heroin overdose and then being on that one and hearing someone come over and say, I have no more officers left and we had three more people overdose.
HARPER: All told, there were at least 174 overdoses in six days across the county. It's died down since then, but not by much. There are usually 20 to 25 overdoses a day. Police are calling it the new normal.
LANDRUM: We got him.
HARPER: About an hour into her shift, Officer Landrum gets a call. A man has overdosed in an apartment building on the outskirts of town. His girlfriend found him and called 911. We head over, and by the time we get there there's a crowd outside. The man is in the back of the ambulance, and EMTs has given him three doses of Narcan, the opioid overdose antidote. For a heroin overdose, one round of Narcan is usually enough.
UNIDENTIFIED MAN #1: He's waking up slowly...
UNIDENTIFIED MAN #2: ...Usually go to Narcan.
UNIDENTIFIED MAN #3: Yeah. He's awake.
UNIDENTIFIED MAN #2: Come on, man.
HARPER: At first they think the man is waking up, but something's wrong. They turn off the music blaring in the ambulance and continue working. After a few minutes, Officer Landrum gives me an update.
LANDRUM: He's gotten four Narcans so far and he's still not awake.
HARPER: The EMTs decide to take him to the hospital. We follow, not knowing if the guy will make it.
LANDRUM: Whatever he got ahold of is really bad.
HARPER: Heroin is nothing new in Cincinnati, but recently the city has seen a shift to synthetic opioids. Last year, there were fewer deaths from heroin than there were from fentanyl. Carfentanil is 100 times as strong. It's used to sedate elephants, and it can be dangerous to even touch it. For first responders, the arrival of carfentanil can be summed up with one word - more. More overdoses, more Narcan, more time spent on each call, and when the efforts to save someone's life fail, more work gets passed on to the Hamilton County Coroner's Office.
BOB TOPMILLER: The caseload keeps getting larger and larger.
HARPER: Bob Topmiller heads the toxicology section at the crime lab where they test blood and urine.
TOPMILLER: You know, we may have had a 100- or 150-case backlog a year ago, and it's almost doubled.
HARPER: Evidence of the deluge is all over the lab. Equipment spills into the hallways, envelopes cover the intake desk, and everyone seems to be busy. But it's not just the number of cases causing the flurry of activity.
LAKSHMI SAMMARCO: It's what we don't know about this drug that scares us.
HARPER: Dr. Lakshmi Sammarco is the coroner for Hamilton County.
SAMMARCO: We don't know what the lethal level really is. It's not meant for human use. So this is one of those things where we're learning as we go and trying to extrapolate some information from the testing that we're doing.
HARPER: Information like the lethal dose per kilogram of body weight, how long carfentanil stays in someone's system - things that could help the people treating the overdoses. Sammarco says this process is part of a pattern they've dealt with before, playing catch-up with the drug suppliers.
SAMMARCO: You know, what's the next thing that they're going to do? What's the next thing? However, in the spectrum of opiates, this is about max. Out of all of them, carfentanil really is the most potent. We don't know of anything else that's more.
HARPER: For now, with so little knowledge, Sammarco can only say that there have been eight deaths so far where carfentanil might be the cause. They're working to test samples dating back to July, when the drug first showed up in Ohio.
Paramedics transferred the overdose victim to the hospital, and after about a half an hour, doctors and nurses were able to stabilize him. Officer Landrum and I left after that. The man didn't have any drugs on him, so he wasn't charged with anything, and his girlfriend wouldn't say where the drugs came from.
LANDRUM: She said him and her overdosed a week ago. And believe it or not, we'll probably be responding out for her here shortly.
HARPER: Even after close calls, people keep using. What's worse, the danger of carfentanil seems to act as an advertisement, that near-death means a really good high. Landrum and others say people are coming from out of town to buy it. The DEA says carfentanil has been confirmed in two states so far. Others are starting to test for it, bracing for its arrival.
For NPR News, I'm Jake Harper.
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